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Patient experiences and ideas are key components for improving health promotion and prevention. Engaging patients and other stakeholders in sharing their practices and ideas is nowadays crucial to increase the legitimacy, credibility, and acceptability of the decisions in these fields, by fostering community wisdom. The World Café is a participatory method suitable to involve a large number of actors to propose creative solutions based on their different knowledge and experiences. However, the diffusion of this approach is not uniform in the various countries and health topics. This review summarises the specific topic, the study design, the number and the characteristics of participants, as well as the main findings and the purpose of the studies regarding the application of this method to health promotion and prevention. Among other results, it was found that the World Café is an appreciated, inspiring, and flexible participatory process often used in association with one or more other methods, to explore emergent themes or topics, to collect best practices or suggestions, to generate improvements or recommendations, and to define priorities for the implementation of projects or research agendas. The results highlight the potentiality of the World Café whenever an issue is not well defined and needs to be explored through deep and several insights. The method allows the exploitation of creativity and collective wisdom when qualitative and in-dept results-more than quantitative and statistically rigorous ones-are appropriate.

Nowadays, due to globalisation, the likelihood that infectious diseases spread rapidly is extraordinarily high. SARS and COVID-19 are two diseases of the Coronavirus family, which developed in China and then spread internationally, causing global public health emergencies. This study investigates the role that risk management and communication systems played in mitigating these emergencies, to establish how they should be improved in the future.A narrative review was carried out to investigate different knowledge domains, such as risk management and communication, risk assessment and indicators, epidemiological and clinical data, diagnostic methods, vaccines, public health and social measures.On one side, risk management systems assess the main data, knowledge, and indicators on epidemiology, diagnostics, and vaccines (science-based); on the other side, they apply public health and social measures (socially-based). Decision-makers, in fact, implement their actions by constantly balancing these two sides (policy-based).A correct crisis management approach should support the governance of pandemics, by harmonising the actual risks assessed by experts with those perceived by the general population. It should incorporate not only the biological, but even the environmental, social and economic aspects of virus emergencies, towards establishing a suitable framework to deal with possible future pandemics.

Nowadays, patient-centred practice represents the key for quality and successful outcomes in healthcare. At the same time, shared decision-making is acknowledged as the highlight of patient-centred care. Informed consent, whenever derives appropriately from a two-way communication between doctor and patient, follows a negotiation process that leads to appropriate and shared decisions. This article aims to show how the typical negotiating styles can lead or not to effective informed consent and conflict mediation processes. To this end, the three negotiating styles currently theorized (sharks, saints, and samurai) are integrated into the three clinical models of doctor-patient interaction (paternalistic, interpretative and autonomist). Currently, being any paternalistic attitude disapproved both ethically and legally, the model of autonomy is the only suitable one to communicate effectively. A concrete case from cardiology is reported to show the different negotiation styles within a doctor-patient conversation. Upstream, drawing inspiration from the samurai negotiating style, the doctor could find a new approach to effective informed consent. Downstream, during mediation, he/she could recompose all those conflicts that stem from an unsatisfying relationship with the patient. These results suggest, finally, that the physicians should be aware of their own prevalent negotiating style and of how to improve it if necessary.

Telomeres are repetitive DNA-protein sequences located at the end of chromosomes and play an essential role in preserving information in our genome by protecting against end-to-end fusion, nucleolytic degradation, breakage, and inappropriate recombination. The telomeres shorten with aging and this process can be affected by oxidative stress and inflammation. Environmental and occupational factors may contribute to telomere length (TL) shortening, as demonstrated by an increasing number of studies. In particular, air pollution was associated with aging-related health outcomes and molecular alterations, such as telomeric shortening. Leukocytes are widely used for TL measurement. However, buccal and salivary cells have more intimate contact with airborne pollutants and are easier to sample. The objective of this review was to identify whether salivary or buccal TL represents a valid marker for evaluating the effects of pollution on health. The reviewed studies investigated the association between TL and occupational exposure (genotoxic substances in mechanical workers, and pesticides in pesticides applicators), residential traffic exposure (NO

SARS-CoV-2, responsible for the current pandemic, is a novel strain of the Coronaviridae family, which has infected humans as a result of the leap to a new species. It causes an atypical pneumonia similar to that caused by SARS-CoV in 2003. SARS-CoV-2 has currently infected more than 9.200.000 people and caused almost 480.000 deaths worldwide. Although SARS-CoV-2 and SARS-CoV have similar phylogenetic and pathogenetic characteristics, they show important differences in clinical manifestations. We have reviewed the recent literature comparing the characteristics of the two epidemics and highlight their peculiar aspects. An analysis of all signs and symptoms of 3,365 SARS patients and 23,280 COVID-19 patients as well as of the comorbidities has been carried out. A total of 19 and 75 studies regarding patients with SARS and COVID-19, respectively, were included in the analysis. The analysis revealed an overlap of some symptoms between the two infections. Unlike SARS patients, COVID-19 patients have developed respiratory, neurological and gastrointestinal symptoms, and, in a limited number of subjects, symptoms involving organs such as skin and subcutaneous tissue, kidneys, cardiovascular system, liver and eyes. This analysis was conducted in order to direct towards an early identification of the infection, a suitable diagnostic procedure and the adoption of appropriate containment measures., Journal of Preventive Medicine and Hygiene, Vol. 62 No. 1 (2021): 2021621

Sexually transmitted diseases (STDs) among adolescents and young people represent a significant public health problem that generates a pressing requirement of effective evidence-based education to promote primary and secondary prevention. The objective of the study is to evaluate how knowledge, information needs, and risk perception about HIV and STDs can change after targeted education interventions for students. A total of 436 subjects aged 15–24 attending high school (134 biomedical and 96 non-biomedical fields) and university courses (104 scientific and 102 non-scientific disciplines) were enrolled to respond to a questionnaire before and after the intervention. An improvement in knowledge was found in all groups, with statistically significant knowledge score differences between the four groups in 60% of the items. More than 94% of the students consider it useful to promote information on these issues. Receiving this information generated awareness and safety in more than 85% of high-school students and 93% of University students. Students widely perceived a great risk being infected with HIV/STDs, although pregnancy was seen as a more hazardous consequence of unprotected sex. This study shows that educational interventions are effective in improving knowledge, apart from findings about key knowledge topics, information needs, and risk perception, which provide significant insights to design future targeted education programs.

[Transformative mediation in the era of the patient revolution. A model for the management of clinical and legal risk in Italian health facilities]Nowadays, too many patients do not perceive that their doctors are exclusively dedicated to care them. This is probably because current health systems are too focused on physicians and diseases, rather than on patients. Such systems are also expensive, fragmented, inefficient and often cynical, generating not only the anger but also the willingness to bring legal claims from many patients. Many scholars, in fact, claim that "too much medicine" can bring more harm than good to the patients and to the health systems themselves, therefore promoting a more sober and respectful medicine. This is the vision of the "patient revolution" and the idea that inspires some other movements that aim to break the vicious circle of greed and cynicism that damages not only patients but also health professionals. Within the same vicious circle, an exponential increase in litigations takes place, as an additional negative effect of the system focused on the disease and on the doctors instead of on the patient.In the present article, we assume that a greater participation of the patient in the choices concerning his/her own health is the fertile ground in which concrete solutions can be found to many problems arising from the current medicine. We therefore analyze the main advantages of active patient participation, which in turn generate a reduction in health conflicts. Based on this analysis, we propose a model in which through various approaches, tools and methods - starting from the upstream prevention of the conflicts - we can also manage them downstream, for the benefit of both patients and health professionals. Finally, we show that within this framework, transformative mediation is an essential approach for weakening many legal disputes and repairing the relational damage generated upstream, where communication has failed or is completely lacking in the clinical practice.

Inappropriate ionising medical imaging has been escalating in the last decades. This trend leads to potential damage to health and has been associated to bioethical and legal issues of patient autonomy. While the doctrine underlines the importance of using informed consent to improve patient autonomy and physician-patient communication, some researchers have argued that it often falls short of this aim. There are basically two different informed consent practices. The first — the so-called “event-based model” — regards informed consent as a passive signature of a standard unreadable template, performed only once in each medical pathway. The second — the so-called “process-based model” — integrates information into the continuing dialogue between physician and patient, vital for diagnosis and treatment. Current medical behaviour often embraces the event-based model, which is considered ineffective and contributes to inappropriateness. We sought, in this review, to analyse from juridical and communication standpoints whether process-based informed consent can deal with scientific uncertainties in radiological decision-making. The informed consent is still a distinctive process in defence of both patients’ and physicians’ health and dignity in rule-of-law states and consequently in curtailing the abuse of ionising medical radiation. • Inappropriate ionising medical imaging is widespread and increasing worldwide. • This trend leads to noteworthy damage to health and is linked to the issue of patient autonomy. • Some authors have argued that informed consent often falls short of improving patient autonomy. • Process-based informed consent can deal with scientific uncertainties to contrast inappropriateness. • Informed consent is still a distinctive process in defence of both patients and physicians.

[ Mediation in health care. Inappropriate use of ionizing tests, informed consent and opportunity of Legislative Decree n. 28/2010] Inappropriate use of ionizing tests in medicine represents an increasing trend, which causes noteworthy damages to health, as well as a huge increment of health expenditures, waiting lists, organizational conflicts, judicial disputes, and insurance compensations. This phenomenon is strictly related to the key bioethical and legal issue of patient’s autonomy, which is protectable by means of a correct implementation of informed consent. The current practice of the passive signature on incomplete and unreadable informed consent templates belongs to the so-called “event-based” approach. This practice mortifies the patient’s right to decide freely and deliberately, being him unaware of the biological consequences of diagnostic-therapeutic interventions on himself and on his progeny’s health. On the other hand, physicians themselves are not protected, since they can generate arbitrary clinical acts more frequently, with heavy deontological and legal consequences. Conversely, a “process-based” approach is necessary, which conveys informed consent in a series of other clinical and organisational processes towards a full therapeutic alliance among physician and patient. Actually, in both the presence and absence of the inauspicious event recurring also in the area of imaging as well as in other specialist areas, an arbitrary informed consent is the cause of deep conflicts, especially at relational level, between physician and patient. The authors suggest – in both juridical and communication perspectives – that these conflicts deserve to be properly analyzed and brought to the surface by the parties through the tool of mediation in healthcare, provided by Legislative Decree n. 28/2010. This tool is oriented not so much towards a technical solution at all costs, as towards a reconstruction of the care relationship, which unfortunately is lacking in the current way of conceiving and managing informed consent.

Guidelines on informed consent for clinical practice exhort physicians to use standard plain language to enhance patient comprehension and facilitate shared decision making. The aim of this study was to assess and improve quality and readability of current informed consent forms used in cardiology. We evaluated the currently used informed consent forms, previously written in Italian and English, of 7 common imaging examinations, according to the recommendations of scientific societies. For each text, we also developed a revised informed consent form according to reference standards, including Federal Plain Language guidelines. Regarding readability scores, we analyzed each text (standard and revised) with Flesch-Kincaid (F-K) grade level (higher numbers indicating harder-to-read text) and the Italian language-tailored Gulpease level (from 0 [difficult] to 100 [easy]). Overall quality and readability was poor for both the original English and Italian versions, and readability was improved with the revised form, with higher readability evidenced by changes in both F-K grade level (standard 10.2 ± 2.37% vs. revised 6.5 ± 0.41%; p < 0.001) for English and Gulpease (standard 45.7 ± 2% vs. revised 84.09 ± 2.98%; p < 0.0001) for Italian. In conclusion, current informed consent forms are complex, incomplete, and unreadable for the average patient. Substantial quality improvement and higher readability scores can be achieved with revised forms that explicitly discuss risks and are prepared following standard recommendations of plain writing.

Guidelines on informed consent for clinical practice and research trials recommend the use of standard plain language to enhance patient comprehension and to facilitate shared decision-making. Aim: To assess readability of our current informed consent forms used in cardiology.

Appropriateness in imaging studies is recognized as an important feature in National Health Services, especially in those nations where per capita health spending has been substantially increased. This is important in view of the projected spectacular rise of ionizing imaging tests in next years; yet their explosive growth in performance is challenging to be interpreted as it may represent an added value when appropriate, and an added cost when inappropriate or overused (Picano, 2009). In order to define this, over the past thirty years researchers have conducted several studies to examine the relationship between risks and perceived usefulness, attitudes, and the usage of ionizing examinations, embracing the risk-benefit relation as a suggested policy for improving health services. However, until relatively recently, little had been done on these issues, and even now, both patients and physicians generally ignore the potential harmful effects of the inappropriate use of diagnostic medical procedures. So, the aim of this review is to discover, basing on the literature, why inappropriateness is still so high and to show that many of the difficulties faced by National Health Services in the reduction of inappropriateness are caused by a lack of awareness of, and training in, communication strategies.

A checking form was introduced in order to test the completeness of electronic and paper patient's charts in a radiotherapy department which had introduced record-and-verify system (RVS) and to improve tha staff performance. The chosen items for the electronic chart were 9 and 5 for paper chart. 223 patients were reviewed in two phases. The data analysis was based on a scoring method, attributing a positive score (+1) to the operator's good behaviour, a negative score (-1) to the lack of data input and a neutral score (0) to the inapplicable situation. The average global score increased from 0.4 to 0.7: in A (lowest complexity) category from 0.37 to 0.64, in B category from 0.4 to 0.89, in C category from 0.48 to 0.61.

Research on risk communication relates basic risk perception studies to the formulation of policies, the currently evolving legislation dealing with hazards, the key issues of public involvement, the risk and environmental management. Risk communication is a relatively new field based on a sociological approach. The discipline comes from risk perception studies (psychological approach), which try to investigate how the public is influenced by certain variables in perceiving risk as "acceptable" or not. Risk communication involves some aspects of risk analysis methodology, since it results that also the technical analysis is influenced by the co-operation between the actors involved. The research project includes two aspects: a theoretic approach on risk communication (Part one) and a case study (Part two). The analysed case is relative to a movement plant of petroleum products. The method used for the analysis foresees a review of the main findings about risk perception and communication: mostly about the factors, which influence the public perception of risk. On the basis of these factors a content analysis of technical documents, of local newspapers, and of public documents and reports was carried out. The main objective of this project is to establish recommendations and proposals for a communication strategy aimed at consensual decision making. This strategy would act on awareness and/or equilibrium in risk perception, as a condition necessary to achieve consensus.

We thank Prof. Vock for his noteworthy and constructive commentary [1]. This gives us the opportunity to briefly provide additional observations to elaborate this topic further. We agree with Prof. Vock that our theoretical approach [2] may not be applied in a non-invasive and low-dose medical imaging. Nevertheless, this makes the innovation that we are trying to develop even more challenging. We are all discussing about something similar to a “paradigm shift”, in the sense described by Kuhn [3]: (a) presenting results “sufficiently unprecedented to attract an enduring group of adherents away from competing modes of scientific activity” and (b) “being sufficiently open-ended to leave all sorts of problems for the redefined group of practitioners to solve.”